Wednesday, April 21, 2010

Poor ovarian reserve as a cause of "unexplained infertility"

One of the most frustrating diagnosis for infertile couples is that of unexplained infertility. In once sense, this is a " non-diagnosis" - it's a confession of our ignorance, and means that we do not know why the couple is not getting pregnant.

Infertile patients find it very hard to understand why doctors cannot pinpoint the problem. Their major fear is that if the doctor cannot even find the problem, how will he be able to solveit ? Even worse, every menstrual cycle is a mixture of hope and dread. Every missed period may represent a pregnancy - finally ! And every time the period starts, the hopes are dashed and the waiting begins all over again !

The good news is that as our technology improves, and we learn more about about reproductive biology, we have developed better tools to diagnose problems which remained undiagnosed in the past.

A very good example of this is the blood test for checking AMH levels.

Women with regular cycles usually assumed that they had good quality eggs. Most gynecologists did so as well, because we really had no good technique for assessing egg quality. Eggs are microscopic, so it's hard to track these ! Doctors would have to depend on indirect tests to check egg quality, such as measuring the follicles in the ovary ( antral follicle count); or testing the FSH level.

While ovarian age usually does correlate well with calendar age, this can sometimes be misleading . Some young women are infertile because they have poor quality eggs . After all, being young does not protect you from having poor quality eggs ! However, they were lulled by their regular cycle into a false sense of security regarding their egg quality , as were their doctors. Most would tell young women who were trying to get pregnant - " Just relax and continue trying - it's the stress ( such a hurtful word !) which is preventing you from having a baby naturally. "

The diagnosis of poor quality eggs in these young women with regular cycles was often missed with great regularity because doctors did not test for this possibility. These women had reached the oopause - but many gynecologists were not even aware of this condition !

Just because you are young does not mean you cannot have have poor quality eggs - fertility problems can occur at any age. Telling a young woman that her egg quality is poor is difficult for a doctor, but it's better to know the truth, even if it is bitter ! I believe that no patient should be diagnosed as having unexplained infertility without getting an AMH level done to assess her ovarian reserve. Not having the right diagnosis made in a timely fashion can cause a lot of heartburn and needless distress later on !